Diverticular Disease - Diverticular, Diverticulosis, Diverticular disease, Diverticulitis

Question 1

Diverticulum

Answer 1

Outpouching in the bowel wall (0.5-1cm)
- Can be acquired or congenital

Question 2

Diverticulosis

Answer 2

Presence of diverticulum without inflammation or infection

Question 3

Diverticular disease

Answer 3

Symptomatic presence of diverticulum

Question 4

Diverticulitis

Answer 4

Infection + inflammation of diverticulum

Question 5

Meckel’s diverticulum

Answer 5

True diverticular of all three layers of the small intestine
Paediatric disorder = failure of obliteration of vitelline duct
Rules of 2:
- 2 years old
- 2 inches long
- 2 ft from ileocecal valve
Dx = TECHNITIUM SCAN

Question 6

Epidemiology

Answer 6

Very common with increasing age >50 (Peak 50-70)

Question 7

Risk factors

Answer 7

Low dietary fibre
Obesity
Sedentary lifestyle
Smoking
NSAIDs
Connective tissue disorder = ED + M
Increased colon pressure = COPD, Chronic cough, age

Question 8

Pathophysiology

Answer 8

Most within sigmoid colon + descending colon but can be right sided or massive single diverticular can occur.
High intraluminal pressure (areas of small luminal diameter, or due to lack of dietary fibre, or COPD) force mucosa to herniate through the muscle layer of the gut at weak points to penetrating vessels

Question 9

Signs

Answer 9

Pyrexia
Lower left quadrant or iliac fossa tenderness and guarding
Rigidity, guarding, rebound or percussion tenderness: suggest perforation
Tachycardic and hypotension: if septic

Question 10

Symptoms

Answer 10

Lower left quadrant pain: (sigmoid colon)
- right colon can be affected in Asian patients
Fresh rectal bleeding
Alternating episodes of constipation + diarrhoea

Question 11

Symptomatic TRIAD

Answer 11

1. LLQ pain
2. Constipation
3. Fresh rectal bleeding

Question 12

Diagnosis

Answer 12

FIRST LINE = Bloods
- Raised WCC, ESR, CRP
GOLD STANDARD = Contrast CT abdomen/pelvis
- Pneumoperitonitis
- Dilated bowel loops
- Obstruction
- Abscess

Question 13

Treatment

Answer 13

Diverticulosis = nothing (wait + watch)
Diverticular disease =
- bulk forming laxatives “ispaghula husk”,
- increased hydration,
- increased fibre content,
- avoid smoking
- GOLD STANDARD = SURGERY
Diverticulitis =
- FIRST LINE = Analgesia (Paracetamol) + Abx = Co-amoxiclav
- Anti-spasmodic = Meberevine
- IV fluid + liquid food
- Rarely surgery

Question 14

Complication

Answer 14

SBP
Obstruction
Fistulae